S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10604
 
                           I N  A S S E M B L Y
 
                                May 8, 2018
                                ___________
 
 Introduced by M. of A. McDONALD -- read once and referred to the Commit-
   tee on Health
 
 AN  ACT  to  amend  the  social  services  law,  in relation to Medicaid
   reimbursement for complex rehabilitation technology for patients  with
   complex medical needs
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. The social services law is amended by adding a new  section
 367-j to read as follows:
   §  367-J.  COMPLEX REHABILITATION TECHNOLOGY; REIMBURSEMENT. 1.  DEFI-
 NITIONS. AS USED IN THIS SECTION:
   (A) "COMPLEX NEEDS PATIENT" MEANS A MEDICAL ASSISTANCE  ENROLLEE  WITH
 SIGNIFICANT  PHYSICAL  OR FUNCTIONAL IMPAIRMENT RESULTING FROM A MEDICAL
 CONDITION OR DISEASE INCLUDING, BUT NOT LIMITED TO: SPINAL CORD  INJURY,
 TRAUMATIC  BRAIN INJURY, CEREBRAL PALSY, MUSCULAR DYSTROPHY, SPINA BIFI-
 DA, OSTEOGENESIS IMPERFECTA, ARTHROGRYPOSIS, AMYOTROPHIC LATERAL SCLERO-
 SIS, MULTIPLE SCLEROSIS, DEMYELINATING  DISEASE,  MYELOPATHY,  MYOPATHY,
 PROGRESSIVE  MUSCULAR  ATROPHY,  ANTERIOR  HORN CELL DISEASE, POST-POLIO
 SYNDROME,  CEREBELLAR  DEGENERATION,  DYSTONIA,  HUNTINGTON'S   DISEASE,
 SPINOCEREBELLAR  DISEASE,  AND CERTAIN TYPES OF AMPUTATION, PARALYSIS OR
 PARESIS.
   (B) "COMPLEX REHABILITATION TECHNOLOGY" MEANS PRODUCTS  CLASSIFIED  AS
 DURABLE  MEDICAL EQUIPMENT WITHIN THE MEDICARE PROGRAM THAT ARE INDIVID-
 UALLY CONFIGURED FOR INDIVIDUALS  TO  MEET  THEIR  SPECIFIC  AND  UNIQUE
 MEDICAL,  PHYSICAL  AND  FUNCTIONAL  NEEDS  AND CAPACITIES FOR BASIC AND
 FUNCTIONAL ACTIVITIES OF DAILY LIVING. SUCH PRODUCTS  INCLUDE,  BUT  ARE
 NOT  LIMITED  TO:   INDIVIDUALLY CONFIGURED MANUAL AND POWER WHEELCHAIRS
 AND ACCESSORIES, ADAPTIVE SEATING AND POSITIONING ITEMS AND ACCESSORIES,
 AND OTHER SPECIALIZED EQUIPMENT SUCH AS STANDING FRAMES AND GAIT  TRAIN-
 ERS AND ACCESSORIES.
   (C)  "INDIVIDUALLY  CONFIGURED"  MEANS  A DEVICE WITH A COMBINATION OF
 SIZES, FEATURES, ADJUSTMENTS OR MODIFICATIONS  THAT  ARE  CONFIGURED  OR
 DESIGNED BY A QUALIFIED COMPLEX REHABILITATION TECHNOLOGY SUPPLIER FOR A
 SPECIFIC  INDIVIDUAL  BY  MEASURING,  FITTING, PROGRAMMING, ADJUSTING OR
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD04523-07-8

 A. 10604                            2
 
 ADAPTING THE DEVICE SO THAT THE DEVICE IS CONSISTENT WITH  THE  INDIVID-
 UAL'S MEDICAL CONDITION, PHYSICAL AND FUNCTIONAL NEEDS AND CAPABILITIES,
 BODY  SIZE,  PERIOD OF NEED AND INTENDED USE AS DETERMINED BY AN ASSESS-
 MENT OR EVALUATION BY A QUALIFIED HEALTH CARE PROFESSIONAL.
   (D)  "QUALIFIED  COMPLEX REHABILITATION TECHNOLOGY PROFESSIONAL" MEANS
 AN INDIVIDUAL WHO IS CERTIFIED AS AN ASSISTIVE  TECHNOLOGY  PROFESSIONAL
 BY  A  NATIONALLY-RECOGNIZED  REHABILITATION  ENGINEERING  AND ASSISTIVE
 TECHNOLOGY SOCIETY.
   (E) "QUALIFIED COMPLEX REHABILITATION  TECHNOLOGY  SUPPLIER"  MEANS  A
 COMPANY OR ENTITY THAT:
   (I) IS ACCREDITED BY A NATIONALLY-RECOGNIZED ACCREDITING ORGANIZATION;
   (II)  IS  AN ENROLLED SUPPLIER FOR DURABLE MEDICAL EQUIPMENT UNDER THE
 FEDERAL MEDICARE PROGRAM AND THE MEDICAL ASSISTANCE PROGRAM  UNDER  THIS
 TITLE;
   (III)  HAS  AT  LEAST  ONE QUALIFIED COMPLEX REHABILITATION TECHNOLOGY
 PROFESSIONAL AVAILABLE TO ANALYZE THE NEEDS AND  CAPACITIES  OF  COMPLEX
 NEEDS PATIENTS IN CONSULTATION WITH A QUALIFIED HEALTH CARE PROFESSIONAL
 AND  PARTICIPATE  IN THE SELECTION OF APPROPRIATE COMPLEX REHABILITATION
 TECHNOLOGY AND PROVIDE TRAINING IN THE PROPER USE OF THE  COMPLEX  REHA-
 BILITATION TECHNOLOGY;
   (IV)  REQUIRES  A  QUALIFIED COMPLEX REHABILITATION TECHNOLOGY PROFES-
 SIONAL BE PHYSICALLY PRESENT FOR THE  EVALUATION  AND  DETERMINATION  OF
 APPROPRIATE   COMPLEX   REHABILITATION   TECHNOLOGY  FOR  COMPLEX  NEEDS
 PATIENTS;
   (V) HAS THE CAPABILITY TO PROVIDE  SERVICE  AND  REPAIR  BY  QUALIFIED
 TECHNICIANS FOR ALL COMPLEX REHABILITATION TECHNOLOGY IT SELLS;
   (VI)  HAS  AT LEAST ONE RETAIL VENDING LOCATION WITHIN NEW YORK STATE;
 AND
   (VII) PROVIDES WRITTEN INFORMATION REGARDING HOW  TO  RECEIVE  SERVICE
 AND  REPAIR  OF  COMPLEX  REHABILITATION TECHNOLOGY TO THE COMPLEX NEEDS
 PATIENT PRIOR TO THE ORDERING OF SUCH TECHNOLOGY.
   (F) "QUALIFIED HEALTH CARE PROFESSIONAL" MEANS A HEALTH  CARE  PROFES-
 SIONAL LICENSED OR OTHERWISE AUTHORIZED TO PRACTICE UNDER TITLE EIGHT OF
 THE EDUCATION LAW, ACTING WITHIN HIS OR HER SCOPE OF PRACTICE.
   2.  REIMBURSEMENT  AND  BILLING PROCEDURES. (A) THE COMMISSIONER SHALL
 MAINTAIN SPECIFIC REIMBURSEMENT AND BILLING PROCEDURES UNDER THIS  TITLE
 FOR  COMPLEX  REHABILITATION TECHNOLOGY PRODUCTS TO ENSURE THAT MEDICAID
 PAYMENTS FOR SUCH PRODUCTS PERMIT ADEQUATE ACCESS TO SUCH  PRODUCTS  AND
 SERVICES  FOR  COMPLEX  NEEDS PATIENTS AND TAKE INTO ACCOUNT THE SIGNIF-
 ICANT RESOURCES, INFRASTRUCTURE, AND STAFF NEEDED.
   (B) THE COMMISSIONER SHALL MONITOR THE ADDITION OF NEW  BILLING  CODES
 FOR  COMPLEX REHABILITATION TECHNOLOGY BY THE MEDICARE PROGRAM AND SHALL
 EXPEDITIOUSLY INCORPORATE SUCH CODES UNDER THIS SUBDIVISION.
   (C) WHERE REIMBURSEMENT RATES FOR  COMPLEX  REHABILITATION  TECHNOLOGY
 PRODUCTS PROVIDED UNDER SECTION FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC
 HEALTH  LAW  OR  SECTION  THREE  HUNDRED  SIXTY-FOUR-J OF THIS TITLE ARE
 DETERMINED BY A MANAGED CARE  ORGANIZATION,  THEY  SHALL  BE  DETERMINED
 CONSISTENT WITH THIS SUBDIVISION. THE COMMISSIONER MAY ESTABLISH MINIMUM
 BENCHMARK  REIMBURSEMENT  RATES TO BE PAID BY MANAGED CARE ORGANIZATIONS
 UNDER THIS PARAGRAPH.
   § 2. This act shall take effect on the first of April next  succeeding
 the date on which it shall have become a law.